Hypernatraemic dehydration

DEFINITION

Serum sodium >145 mmol/L
- mild: 146–149 mmol/L
- moderate: 150–160 mmol/L
- severe: >160 mmol/L

Most common cause is failure to establish adequate oral intake while attempting breastfeeding

To prevent/treat hypernatraemic dehydration while encouraging breastfeeding

Identify babies at risk
Immediate skin-to-skin contact at birth and breastfeed within 1 hr of life
Offer breastfeeding assistance within 6 hr of life
Assess baby to ensure feeding adequate
Ensure baby feeds ≥6 times within 24 hr
If baby reluctant to feed, express breast milk (see Breast milk expression guideline) and offer by cup or syringe
Calculate required volume of feeds (see Nutrition and enteral feeding guideline)
Avoid bottle feeding as far as possible and avoid dummies
Assess feeding, number of wet nappies and stools using Table
Avoid early discharge of at-risk babies
Early reweighing of at-risk babies (at 72–96 hr) with breastfeeding support can reduce severity of hypernatremic dehydration

Day	Wet nappies	Stool
1–2	≥2/day	>1/day
3–4	≥3/day	≥2/day, changing in colour and consistency
5–6	≥5/day	≥2/day, yellow in colour
Weigh between 72 and 96 hr Refer all who have lost >10% weight weight loss % = weight loss (g)/birth weight (g) x 100

Irritability/high pitched cry: unsettled during breastfeeding
Prolonged feeding >45 min
Demanding <6 feeds in 24 hr
Reduced urinary frequency
Delayed change from meconium to transitional stools
Weight loss
Fever
Jaundice
Lethargy/altered level of consciousness
Tremor
Increased tone
Doughy skin
Seizures (usually during rehydration)
Physical examination may be unremarkable
Usual signs of dehydration (sunken fontanelle, dry mucous membrane and reduced skin turgor) may be absent

See Guideline Supporting Information

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